1993 Legislative Session: 2nd Session, 35th Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

MONDAY, APRIL 26, 1993

Afternoon Sitting

Volume 9, Number 7

[ Page 5429 ]

The House met at 2:04 p.m.

Prayers.

H. Lali: With us in the gallery we have two gentlemen from the town of Hope in my riding: Mr. Peter Kennedy and councillor Larry Ortis. I think these two gentlemen are going to be really pleased that later on this week I'll be delivering a half-million dollar cheque to the district of Hope. Would the House please make them welcome.

J. Weisgerber: Also in the galleries is a former member of the Legislature. I'd like the House to welcome Russ Fraser. Russ was the first person to demonstrate just how effective someone from outside of the legal profession could be as Attorney General. Would you please make him welcome.

J. Beattie: There is an individual in the gallery today who.... I'll just have to say that she's my constituency assistant and everyone will know just how important she is to me as an individual. I'd like the House to please make welcome Lone Jones.

P. Dueck: Visiting us today from the constituency of Matsqui we have roughly 50 students from a private school, the Mennonite Educational Institute. They're here, ever-growing, ever getting larger. With them are two teachers, Mr. Peter Reimer and Henry Zukowski, as well as some adults. Would the House please make them welcome.

Hon. T. Perry: I have the pleasure to introduce in the gallery -- adjacent to the former Attorney General -- Joan and Howell Breece of Sausalito, California. I'm sure that were she here, the Minister of Tourism and Culture would be delighted to acknowledge that they are here all the way from California to attend the fabulous Dixieland Jazz Festival in Victoria. Would the House please make them welcome.

Hon. J. Cashore: Present in the gallery today are 64 grade 7 students from Ranch Park Elementary School in Coquitlam. Would the House join me in making them welcome.

Ministerial Statement

TEACHERS' STRIKE

Hon. M. Sihota: From time to time questions have arisen about the scope of

section 72 of the Labour Relations Code, which was introduced by this government last session.

Section 72 is the

section of the legislation dealing with the provision of essential services. On April 19, 1993, School District 85 -- the Vancouver Island North School District -- made an application to the Labour Relations Board pursuant to

section 72, seeking a determination as to whether the provision of education to grade 12 students falls within the ambit of

section 72. The board had argued that the current teachers' strike, which commenced, I believe, on April 15, threatened the ability of 150 grade 12 students to graduate, and left them inadequately prepared to write provincial exams.

On April 23, 1993, the chair of the Labour Relations Board, Mr. Lanyon, wrote to me saying:

"Please find enclosed a report dated April 21, 1993, by special investigating officer Wayne Mullins regarding the above matter.

"After reviewing the report, I am satisfied that a strike by the Vancouver Island North Teachers' Association members would pose a threat to the health, safety and welfare of the public in general. I request that you direct the board to act under the provisions of

section 72(2) to 'designate as essential services those facilities, productions and services that the board considers necessary or essential to prevent immediate and serious danger to the health, safety or welfare of the residents of British Columbia'."

Hon. Speaker, in light of that letter, I have written to Mr. Lanyon and agreed that there should be a further investigation of the issue pursuant to

section 72 and, in particular, to

section 72(1).

Section 72(1) of the legislation states: "If a dispute arises after collective bargaining has commenced, either of the parties to the dispute may apply to the chair to investigate, or the chair on his or her motion may investigate, whether or not the dispute poses a threat to the health, safety or welfare of the residents of British Columbia, and report the results of the investigation to the minister."

Hon. Speaker, I wish the board well in its determination of this issue, which will, I'm sure all members would agree, in all likelihood be precedent-setting.

G. Farrell-Collins: Here we have a fine example of Bill 84 finally coming home to roost on the Minister of Labour. Hon. Speaker, we debated

section 72 in this House for almost a whole week, and we dealt with these issues in relation to education.

For the last year we have seen an unprecedented level of labour disruption in the education field in this province. We argued time and time again that

section 72 needed to be amended to include education as an essential service, and this minister argued against it. What we need from this minister is some leadership and some guidance -- not referring it to another committee to investigate. All this minister needs to do is provide an amendment to the code to allow this to take place. Or if he wishes, he could merely accept Bill M210 standing in my name on the order paper, which would allow education to be declared an essential service and allow the process to take place.

What the students of this province need is some action, not another NDP committee. It's time this minister stood up and did what's right for the students of this province: get his butt in gear and start delivering some of the things they promised.

J. Weisgerber: First of all, let me say that I would support the referring of this for further investigation, but I also want to echo the words of the member for Fort Langley-Aldergrove. Last fall we debated Bill 84 at length, and we warned the minister time and time

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again, day after day, about the dangers that taking education out of the essential services category represented for students in British Columbia. Now, six months later, this minister is seeking the support of the House to refer the question to the Labour Relations Board. We should deal with this issue, but I don't accept the notion that only grade 12 students are at risk. The health and welfare of all students is affected by Bill 84 -- by the legislation as it exists today -- and I would encourage the minister to broaden the scope to include all education, K through grade 12, as an essential service.

Oral Questions

HEALTH CARE ACCORD

L. Reid: The hospitals in British Columbia have rejected the backroom accord negotiated by the Minister of Finance for the Minister of Health. They rejected it because it was too expensive. Will the Minister of Health tell this House whether more money is being put on the table to get the hospitals to buy in, and has this extra money been taken from the proposed employees package or from the taxpayers?

Hon. E. Cull: I'd like to point out to the member that 55 percent of the vote went in favour of this accord. However, the HLRA's own information on the accord -- information that I know has been provided to the member -- points out very clearly that it will cost the hospitals of this province more money without the accord than it costs them with it. We saw the first example of that today, with the Greater Victoria Hospital Society's chief executive officer saying that his budget shortfall is going to be at least $2 million to $3 million more as a result of not having this accord.

[2:15]

L. Reid: It's interesting to me that 55 percent voted in favour; it's simply not enough. Their own legislation takes at least two-thirds.

If the minister is denying that it will take more money to get the players back to the table, will she tell this House why the deal was rejected?

Hon. E. Cull: At this point I haven't had an opportunity to talk to the hospital boards around this province about why they may have voted no. But a number of things have been suggested as reasons for the accord not passing with the sufficient majority that was required. Some of it has to do with some of the uncertainty around things that were to be arbitrated in meetings starting today, which, unfortunately, have not taken place. We will be meeting with the parties and urging them to get back to the table to examine what the underlying reasons were for the insufficient number supporting the accord.

We will start from there to see what we can do to put together an agreement that will allow the province to move forward with very necessary health care reform.

L. Fox: My question is to the Minister of Health. Given that the minister was so convinced that the Finance minister's proposed health care pact was a good deal for health care employers, why was she unable to persuade them to vote for it, and how does she account for the failure of this landmark giveaway?

Hon. E. Cull: I don't think anything has changed very much since the HLRA put out their own recommendation in favour of this accord. Two of the compelling reasons they gave for endorsing the accord were: "Ensuring a first-class health care system is a daunting task without employer and union cooperation. The HLRA believes that the accord provides the cornerstone of that cooperation." They also said that the changes in wages and in the contract language are the best deal for employers, when other alternatives are considered.

I think that those reasons for endorsing an accord between the hospitals, the health care professionals who provide health care service in this province and the government still stand, and they are still good reasons for us to get back together and continue discussions.

L. Fox: I'm surprised at the rhetoric we keep hearing from the Health minister. At a time when industry in British Columbia is being forced to accept layoffs just to succeed, why did this government ever agree to a no-cuts contract for one sector of public employees?

Hon. E. Cull: The member is clearly misinformed and hasn't done his homework. First of all, this accord provides for the reduction of 4,800 FTEs over the three years of the agreement. Again, from the HLRA's own calculations, the cost estimates are lower in every case for each of the three health care unions than they are without the accord.

L. Fox: The minister suggests that this deal would allow the government to eliminate 4,800 employees over three years, yet every one of those employees affected would be guaranteed new government jobs elsewhere in the same region, at equal pay and responsibility. Why would the government fire 4,800 health care employees, then rehire them at the same salary in the same region? Where are the cost savings to the taxpayer?

Hon. E. Cull: Again, hon. Speaker, the member simply hasn't done his homework. Part of the 4,800 FTEs would be eliminated through attrition: through people moving out of those jobs, moving from one community to another or moving to other provinces; and through early retirement. When we're talking about the nurses and health care professionals who look after people when they're ill, I have to say that I want them in the health care system. I want them still employed in this province.

CORE CALL FOR INQUIRY INTO GOVERNMENT'S MAC-BLO SHARES

F. Gingell: Hon. Speaker, the Minister of Finance has tried to assure us that the B.C. Endowment Fund is independent and operates at arm's length. We now know that both the Minister of

[ Page 5431 ]

Finance and Minister of Forests were briefed on the decision to buy Mac-Blo shares. In light of this additional information, will the Deputy Premier now ask Ted Hughes to conduct an independent investigation?

Hon. C. Gabelmann: On behalf of the Deputy Premier, let me say to members of the House that the issue raised by Mr. Owen last week is a serious issue, one that we want to treat carefully and properly. Let me say that late last week this issue was discussed with Mr. Hughes. Let me say also that in our efforts to make sure we accomplish this task properly, without any evidence or suggestion by anyone that we're embarking in a way that isn't entirely appropriate, we want to make absolutely sure that this is the appropriate way to go.

We want to make sure that at the time the Financial Administration Act was amended -- in 1988, I believe -- Mr. Hughes' participation as the Deputy Attorney General is not something that might in the future create a problem. We are treating the issue seriously, as one that we want to have handled in an entirely appropriate way, and we will take the necessary time to do that.

F. Gingell: Conflict of interest is a matter of perception. It is critically important that this government act now to give the people of British Columbia the guarantee that due process will take place. The speech is fine, but will the Attorney General make the commitment now that a form of investigation -- whether it be through the conflict-of-interest commissioner or some independent body -- takes place immediately?

Hon. C. Gabelmann: Last Thursday in the House I indicated that the government sees no conflict in this matter whatsoever, that the Financial Administration Act...

Interjections.

Hon. C. Gabelmann: If members would just hold on, I'll answer the whole question.

We indicated that in our view the Financial Administration Act was clear. It provided for just this kind of eventuality, and that there was no problem whatsoever. Having said that, Mr. Owen has made his comments. Many members of the opposition appear to share those views, and many members of the public are concerned and don't understand fully what's at issue here. For those reasons, we are taking all of the necessary steps to make sure that we can resolve this matter to everyone's satisfaction as quickly as possible.

BUDGET CONSULTANT

A. Cowie: My question is to the Deputy Premier. The Finance minister confirmed on the weekend that Ms. Maloney was paid to consult on the B.C. budget. My question is: was Ms. Maloney contracted to consult as an expert on tax law, and was she contracted through the University of Victoria?

Hon. A. Hagen: On behalf of the Minister of Finance, I'll take that question on notice.

Interjection.

The Speaker: The question has been taken on notice, hon. member, and I cannot allow a new question or a supplemental. I'll recognize the hon. member for Okanagan West.

CORE CALL FOR INQUIRY INTO GOVERNMENT'S MAC-BLO SHARES

C. Serwa: My question is to the Minister of Environment. Stephen Owen has insisted that the government's Mac-Blo share purchase be reviewed by the conflict-of-interest commissioner. Given that this is critical to the integrity of the CORE process and given how critical CORE is to the minister's mandate, will the minister stand up right now and endorse Mr. Owen's request?

Hon. J. Cashore: Hon. Speaker, I will stand up right now and endorse everything the Attorney General has just said.

C. Serwa: It's lamentable that something as important as the CORE process gets that type of offhand remark from the Minister of Environment. Does he or does he not agree that the Mac-Blo share purchase must be referred to Ted Hughes if CORE is to be perceived as neutral, unbiased and legitimate by everyone at the table?

Hon. J. Cashore: The Attorney General has explained the reason that the government is approaching it in the way it is. It is taking the recommendation very seriously. Everybody agrees that CORE is very important. The hon. member is seeking to draw something out of this that simply isn't there. I would call upon the hon. member, if he really supports the CORE process, to enable the government to follow through on this in the appropriate manner, which is now taking place.

C. Serwa: The final supplemental is to the Deputy Premier. Is it the position of this government that any minister of the Crown whose conduct is directly under investigation by the conflict-of-interest commissioner must immediately resign?

Hon. A. Hagen: Hon. Speaker, it is not possible for me to answer a hypothetical question such as the one the member has just asked me.

PRIVATE ADOPTIONS

V. Anderson: Hon. Speaker, my question is to the Minister of Social Services. The minister stated in the Vancouver Sun last Saturday: "The ministry will continue to seek the comments and recommendations on the review of provincial adoption legislation." Will the minister undertake today to provide a draft bill to the public before it is presented to the Legislature so the public may have full opportunity to respond?

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Hon. J. Smallwood: For the member's information and further clarification, there are two stages to the work that is underway with the adoption policy: (1) to regulate; and (2) to define the broad number of issues impacting adoption in this province. The legislative review that is underway and was very clearly advertised in all the papers has invited people either to write, fax or phone to our 800 number their points of view and the issues they hope would be dealt with. That is just one of the venues that is engaging this province in the discussion around adoption.

V. Anderson: The minister has confused the people of this province with her statements. Would the minister please respond to her comment of last Saturday: "The adoption debate strikes at the heart of our community values." Why then will the minister not undertake to make her full proposals clear to the people of the province so that they might clearly understand what she is contemplating and be able to respond?

Hon. J. Smallwood: Once again, the legislation that is contemplated for this session does one thing and one thing only: it deals with the regulation of private adoption. For the member's information, there are a number of significant issues that are raised by adoption. That extensive review will take place over the next year. It will be a comprehensive, inclusive review which will include all British Columbians in defining the delivery of adoption services for this province.

L. Reid: I rise to move an emergency debate now take place pursuant to standing order 35.

The Speaker: If the member would like to make her statement.

L. Reid: Hon. Speaker, the health care accord under the labour relations association is still being negotiated. Health estimates are due to commence momentarily. The ongoing negotiation impacts on the budget process of this entire administration. Employer groups in this province do not have confidence in this government's ability to fund the agreement.

[2:30]

Clearly, public concern over the actions of this government and its inability to disclose the true costs of this agreement constitutes a matter of urgent and pressing public importance to the taxpayers of this province and must be debated in this House.

Hon. M. Sihota: Hon. Speaker, it seems that some members of the Liberal Party have discovered the rule book but don't understand the spirit behind the various regulations. First of all....

Interjections.

Hon. M. Sihota: I'm glad they've now been silenced, so perhaps they can learn something. First of all....

Interjections.

The Speaker: Would the House come to order, please. I'm sure the Government House Leader will make his submission on the application.

Hon. M. Sihota: First of all, let me say that the issue does not fall within the scope of urgency as defined in standing order 35. Secondly, and more importantly, the hon. member, during the course of her own comments, indicated that we are about to move into Health estimates, which provide an opportunity for all members to discuss the significance of the outstanding accord that's been negotiated between this administration and the hospital industry. Therefore it strikes me that her motion falls on her own argument: namely, that we're about to move into Health estimates.

The Speaker: I thank both members for their submissions. As for the standing order 35 application, I will bring my comments back to the House as soon as possible.

Orders of the Day

The House in Committee of Supply B; E. Barnes in the chair.

Hon. M. Sihota: Hon. Chairman, I wish to advise members of the committee that Committee A is also meeting in the Douglas Fir room to discuss the issues relating to the Ministry of Forests.

ESTIMATES: MINISTRY OF HEALTH AND MINISTRY RESPONSIBLE FOR SENIORS

On vote 47: minister's office, 419,400.

Hon. E. Cull: It's my pleasure today to rise and present the 1993-94 budget of the Ministry of Health and the Ministry Responsible for Seniors. I'm especially proud of this year's budget because it protects and enhances medicare and the health services British Columbians value so highly, while also taking significant steps forward in the new directions we have been working toward since our election. We faced major challenges in my ministry's budget and made some very difficult choices as we work to maintain one of the best health care systems in the world and also to maintain the long-term health of British Columbians.

The mandate of the Ministry of Health is to provide and promote the physical, mental and social well-being of all people in this province. This is a substantial responsibility, one that flows from an understanding of health and recognizes the broad range of factors that contribute to our health. Our mandate requires that the health system do more than it has in the past to pursue good health for all British Columbians. It isn't enough anymore just to wait for health problems to occur before acting and to limit our involvement to treating people once they become sick or injured.

That outdated approach doesn't make sense anymore if we're really concerned about the health of people in this province, because the old adage "an ounce of prevention" is certainly true. In the long run it costs far more to deal

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with the results of shortsighted health policy than it does to help prevent health problems in the first place. That's what our new directions in health care are all about.

On February 2 I announced a package of 38 initiatives called New Directions for a Healthy British Columbia. This is the plan for the future of health care in this province. It focuses on improved prevention and health promotion, greater local decision-making, bringing services closer to home and spending smarter. This plan was developed over a three-year period, starting with the Royal Commission on Health Care and Costs, which worked for 22 months talking to people around the province about the strengths and weaknesses of our health care system and the need for change.

The release of the royal commission's final report in November 1991 was followed by a year of intensive consultation by the Ministry of Health. We heard from hundreds of people who have a day-to-day stake in our health system and from other British Columbians who are concerned about health -- all of us who are consumers of the system and depend on it being there when we need it. The result of this process is a plan that builds upon the findings of the royal commission report.

I just want to take a moment to remind members what the royal commission did tell us about health care in this province. They told us that we had one of the best health care systems in the world and that we should preserve medicare and the excellent services provided by doctors and hospitals. They also noted that not all British Columbians are equally healthy and not everyone has equal access to our health care system. They told us that we hadn't devoted nearly enough attention to the promotion of good health and the prevention of injury and illness.

They told us that the thing we call a health care system, as if it were some well-thought-out and well-integrated set of services, is indeed far from that; it's fragmented, and it has serious overlaps and glaring gaps. Finally, they told us that our health care system is not financially sustainable in the long run. We spend nearly $17 million to operate it each and every day of the year -- $1,800 a year in tax dollars for every person in the province. That cost has increased by 50 percent over the last five years.

The royal commission didn't just give us the problems; they also gave us some of the solutions. One of the things they told us was that our health care system is not under-funded; it's under-managed. They told us there is enough money being spent on health care right now, but unfortunately that money isn't always in the right place, and it isn't always where it can do the most good. So now, with the province facing very tight economic circumstance, we have little choice but to spend smarter, to make sure that every dollar we're spending on health care is working as hard as it possibly can to make us healthier.

Over the past year we started changing our health system to better meet the long-term needs of British Columbians, and we began that in last year's budget. Last year we began a careful process of slowing down spending growth of our well-established treatment services while devoting more resources to community-based services and the promotion of good health. At the same time, we continue to consult widely about the royal commission recommendations, leading to the February 2 announcement of New Directions. Today I think we're very well-positioned to move ahead carefully but expeditiously with needed health care reform.

The impact of these reforms is evident from a look at the 1993-94 budget. At an overall level, the budget provides for a moderate spending increase of 4.3 percent over last year's estimates -- to just under $6.2 billion. This allows for small increases in most areas of the Health budget and more substantial increases to programs that are key aspects of our New Directions for health care.

Strategic and support services will have their spending reduced by 5 percent from last year's estimates. We have made efficiencies in this area so we can reallocate the money to direct patient care.

Community health services, which include prevention and promotion programs and community support services, will receive an increase of 7.4 percent. These services are an essential part of our New Directions. But this relatively substantial increase in resources still leaves it accounting for less than one-quarter of the ministry's total budget.

Funding for hospital care will increase by 4.5 percent over last year's estimates, while emergency health services will increase by 3.2 percent.

The Medical Services Commission budget, which was underspent last year -- let me repeat that: underspent last year -- gets an increase of 3.8 percent over the projected actual 1992-93 spending.

The Pharmacare program continues to be a very challenging area for the control of spending, primarily because 98 percent of the expenditures under the program are payment of claims: the claims come in and we pay them. In the short term, that can only be altered by changing the program criteria. We have budgeted this year for a 3.4 percent increase over actual Pharmacare spending last year, which amounts to 9.5 percent more than last year's estimates.

I'd like to focus the rest of my comments on how this year's budget supports New Directions for a Healthy British Columbia and health care reforms. There are four general themes of New Directions. I mentioned them briefly earlier, but I'll just repeat them. We're spending smarter, increasing local decision-making, bringing health care services closer to home and enhancing our efforts in the area of preventive health care and health promotion.

With respect to spending smarter, the ministry's 1993-94 budget includes support for specific initiatives. For example, the budget allows for progress in coordinating health services at the community level, improving the quality of service and reducing duplication and getting rid of some of the gaps that have been giving us serious problems. The ministry will also improve its ability to track useful health information and to evaluate whether programs are actually contributing to better health.

We will be preparing a health-human resource strategy, and increased financial and management audits will be conducted to identify savings and better ways to do business throughout the ministry and the health care system. Changes to the Medical Services

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Plan premium system will reduce administrative costs to the ministry and improve access to care for low-income British Columbians. Information will be provided to doctors to encourage improved and more efficient drug-prescribing patterns. With respect to the ministry's capital spending, plans have shifted focus from acute care to building long term care facilities, which will save the system money as people who belong in long term care can move out of the more expensive acute care beds into appropriate multilevel care facilities.

In the area of local decision-making, the budget provides support to proceed with the process of establishing community health councils and regional health boards across the province. These boards and councils are already under active formation from many groups in different communities around British Columbia.

There will be enhanced health promotion activities to enable British Columbians to make better informed decisions about their families' health care. With respect to bringing services closer to home, the '93-94 budget will enable us to continue working towards the establishment of community health centres in several communities around the province, communities such as Keremeos, Quesnel, those on northern Vancouver Island and Kitimat, where there are already active plans to establish such centres.

The full impact of recent improvements to our public health services will be felt this year; these include improved immunizations, speech and language services and inspections to ensure public health safety for people in the province.

New mental health services will be provided in communities around the province. Support for informal care providers and respite care funding will be expanded through adult day care and crisis accommodation. This is a very important area, because we depend on informal caregivers to provide an awful lot of the support to people who need health care in this province. Without the informal caregivers' network, we wouldn't be able to provide the quality of service we have.

[2:45]

Finally, the implementation of a Pharmacare computer network this year will ensure that health professionals in the community will have better access to prescription drug information.

In the area of enhanced prevention and health promotion, the budget provides funding for a new provincial health council, as recommended by the royal commission. Resources will also be provided to enhance the mandate of the provincial health officer. That individual will be more like the U.S. surgeon general and will be able to speak out on behalf of people in the province on particular health issues.

We will also be introducing health impact assessments for all new government policy programs and legislation. Additional funding has been provided to support seniors' health promotion; to deal with the abuse of alcohol, drugs and tobacco; to develop strategies for preventing injuries; and to inform British Columbians of ways to improve their own health. More health information will be distributed to the public, including information on the appropriate use of health services and regular reports on the health status of every British Columbia community.

We've come a long way over the past year. Although there have been some difficult issues and some tough decisions, these have been part of a process of undeniably positive progress over the past 12 months. The 1993-94 budget allows this progress to continue. We've maintained a strong commitment to the establishment of the health systems -- such as our hospitals, the Medical Services Commission, Emergency Health Services and Pharmacare. We've provided additional support to the community health services that are bringing health care closer to home for British Columbians.

Even if we wanted to, we can't carry on as we've been doing in the last decade without making changes to the system. The royal commission made that very clear to us: that change is necessary. It is coming whether we like it or not.

If you reflect back 25 years ago when medicare was established in this country, and you think about what it was intended to do at that point and what it is intended to do now, you can see the tremendous growth in expectation and need. In 1962 medicare was introduced so that people wouldn't have to sell their family farm to pay the hospital bill or the doctor's bill. That's essentially what medicare was all about when it was first introduced.

Today -- 25 years later -- we expect medicare not only to cover hospital and doctor services but to cover complementary practitioners to make sure that our aging parents can receive home care or nursing care in their own home -- or if not in their own home, to be able to move into a facility. We want immunizations for our children. We want eating-disorder programs. We want the mentally ill housed and off the streets. The list of things that we now consider basic health care has grown tremendously. For that reason, our health care system has to change if it's to keep pace with the changing needs of our society.

In conclusion, I'd like to take a moment to commend the people who are employed by the Ministry of Health. These dedicated public servants have worked hard during a disconcerting period of change. They've shown a remarkable willingness not only to go along with change but to help lead it. This same positive spirit has also been shown by caregivers throughout the system, organizations that provide health services and British Columbians who depend on health care. That spirit, combined with sensible planning and good decisions, will allow us to carry on from where we are to a health system that's affordable in the long run and one that gives all British Columbians a fair chance to be healthier.

Healthy citizens and healthy communities are our goal, and the 1993 Ministry of Health budget is another step in that direction.

L. Reid: When this government took office it inherited stewardship for a health care system built by taxpayers' money, perfected by dedicated professionals and highly valued by all citizens. The government

[ Page 5435 ]

approached its responsibilities with two assumptions: first, that the health care system was wildly out of control in terms of cost and administration; and second, that the remedy required was massive government intervention. The first assumption was misplaced; the second was a smokescreen for the government's real intention, which was to exercise greater control.

For the first few months, the government enjoyed some modest success in hiding its intentions behind a veneer of consultation and consensus, but nobody is fooled anymore. Throughout this province and at every level of society, people are now asking the same question: how much harm is this government going to do in its one term of office, which it received by default? This government hears that question, and under all the bluster, it is very worried.

In order to make the move to control more acceptable, the government promised three approaches: full consultation before tampering with the health care system; a climate of respect for health care givers; and accurate, open cost analysis before major changes were made.

Instead of consultation, we received a road show -- an assortment of committees. In reality, ministry bureaucrats were preparing a New Direction strategy. When it was announced, it was as much a surprise to all the so-called consultative groups as it was to the general public. Instead of respect for caregivers, we saw a spectacle of broken commitments and back-room deals. Commitments made to B.C. doctors were struck down through legislation. Collective agreements with health care workers were renegotiated through arbitrary intervention in the collective bargaining process.

Instead of open cost analysis, we got a complete restructuring of the health care system, announced in a hefty press kit that contained thousands of adjectives but not a single line of financial analysis.

Like everything else this government has done to date, the restructuring of health care had to pass the test of the government spin doctors. I must say that the success of these communication experts in selling health care changes as a process of consultation has been as laughable as their success in other major areas of government policy. The government spin cycle is a little shaky; maybe it is time for the Maytag repairman.

The minister and her cabinet colleagues were given instructions by the spin doctors to hammer away at two messages. The first message, which we will call the Audrey McLaughlin theme, was that health care was in crisis because of federal downloading. The second theme was that the system was out of control. We have to look at both these excuses in the light of day.

First, dealing with federal transfers. There is no dispute that cash transfer payments from Ottawa to the provinces have been declining. But surely this could not have been a surprise to this government. The established programs financing arrangements, or EPF, were negotiated and implemented in 1977. The original intent was that federal cash contributions to the provinces would be conditional upon the provinces meeting the five principles of medicare. But changes to the program have been underway for more than ten years. They are readily understandable to anyone willing to do their homework.

In 1982 the EPF formula was amended to eliminate the basic cash component from the 1977 arrangement. In 1985 the EPF escalator was reduced by 2 percentage points, and in 1989 it was reduced again. In 1990 the provinces' entitlements were frozen in per capita terms, and the escalator was reduced further. In 1991 the Minister of Finance announced that the per capita freeze in entitlements would be extended to 1994 and 1995.

The Minister of Finance for this government publicly stated that before becoming minister he didn't understand the established programs financing arrangements. I can only assume that the Minister of Health, who defers to this Minister of Finance on any matters of a complex nature, was even less aware of the process. Hon. Chair, what were these people doing for 17 years on this side of the House? The structure of federal transfer payments is a basic in any first-year political science course. For this government to be suddenly discovering a process that has been on stream since 1982, and to use that as a justification for restructuring the health care system, is just not acceptable.

I am not defending the federal position. The facts are that the days of deep pockets in Ottawa are gone. Canada is the most indebted nation, on a per capita basis, of all western industrialized nations. All of the partisan rhetoric from this government is not going to change that. If they are serious about protecting health care, they will stop whining and start managing.

The second communication mantra dictated to cabinet by its communications experts was that health care costs were out of control. Again, the facts do not support this contention. Yes, health care is expensive. Yes, health care constitutes one-third of the provincial budget. When that spending is expressed in per capita or hourly terms, the figures can sound very frightening. But the fact is that the health expenditure, as a percentage of gross provincial product, has essentially remained fixed over the past five years.

The fact is that doctors, the favourite target of this government, actually underspent their entitlement last year. The fact is that practitioners in all the professional fields have been stretched to the limit to make the best use of scarce resources. There is no loss of control. There is no runaway situation requiring the firm hand of the NDP, nor has there been any public outcry about the excessive cost of health care.

The tremendous unrest we see among taxpayers in the province today about the cost of government is not directed at hospitals, nurses, doctors or other professionals; it is directed at the continuing spending by government in areas that the public simply does not think have priority. Nowhere is this government more cynical and disrespectful of the public than when it uses health care as a threat.

Each time this government is called upon to review its spending, to limit its patronage appointments, to reduce waste and duplication, all ministers respond with the same robotic answer: "Do you want us to cut health care?" We have to put this in balance, hon. Chair. The government sees the cost of health care as a threat to the growth of government. The public sees the growth of government as a threat to our health care system.

[ Page 5436 ]

In spite of promises of consultation, respect and cost analysis, the government suddenly introduced its blueprint for our new health care system in February. With the usual fanfare that has come to replace substance in this government, a flurry of documents under the title of "New Directions" was released. In the government's words, the goals of the New Directions program were to focus on improved health, to expand public participation, to bring services closer to home, to manage resources effectively and to respect the providers.

It was appropriate that those last two goals were described as a new direction, because they certainly did not characterize this government's approach up to this point.

The government's press release contained heroic commitments. It promised that British Columbians would be the first to know when the government made decisions that affected health. Within two weeks, realizing they were making promises they could never keep, the government was cutting backroom deals with the unions, and they are still at it. Actually, for the NDP, two weeks is a relatively long shelf life for a promise. It was announced that the New Directions policy would ensure that all citizens have equal access to health services.

No attempt was made in any of the documentation to indicate how this would be done or what it would cost. This government has clearly substituted press releases for policy.

[3:00]

The New Directions strategy boasts of 38 initiatives to change health care. When one examines the support material, it is clear that every attempt was made to take any government initiative, no matter how remote, and present it as part of the new health care strategy. They actually included an increase in the minimum wage as one of the important initiatives taken by government to improve health care.

The New Directions strategy raises more questions than answers. For example, what are we to make of the promise that the government will produce health impact assessments on all new government programs? Does this mean that economic policies will be reviewed in terms of their impact on job opportunities? The government has conceded in all its documentation that poverty is one of the principal determinants of poor health. Will NDP policies that discourage capital formation risk and the attraction of investment be labelled as health risks? Perhaps we should quarantine the Minister of Finance.

We note that there will be an increased role for the ombudsman over hospitals, hospital boards and professional bodies. But we see no reference in these estimates to the cost of that initiative. Promises are made to improve public access to health information and to distribute information on health system costs. Again, there is no specific reference to how this will be done or to what it will cost.

The government talks of respecting the providers and ensuring that the management of labour adjustment involves those directly impacted by change. If the government really respects providers, how can it justify the poisonous relationship it has established with the doctors in British Columbia? It promises to involve those most affected by the change in labour adjustment. How can it defend imposing a new arrangement on the Health Labour Relations Association? How can it present these estimates when that secret deal has been placed in uncertainty? I will refer to that in more detail as I proceed.

[L. Krog in the chair.]

The government is now promising a health care report on the health of British Columbians. What application will this have to the Closer to Home strategy? Will it provide in-depth information on more than 90 local health areas in the province? If not, it will be of no use whatsoever in the allocation of resources. How can they use provincewide health data to determine the specific needs of small communities in the province?

As part of the effective management strategy, the government promises to expand alternative physician-payment arrangements. Where is the data that supports the contention that such arrangements automatically lead to more effective management? If this government really believes that capitation -- which means giving each doctor a fixed amount of money to treat a fixed number of patients -- is for the betterment of this province, then they should let the people decide in advance. Is the government proposing that patients over and above a doctor's quota should be treated on the house? Or should they be turned away?

No doubt the control gurus in the Ministry of Health have definitive answers to these questions. I'd like to hear them.

I'll touch in greater detail on the doctors' dispute. But on the issue of alternative payment, I would like to say that the medical association has not been inflexible on this point. But the cabinet has been instructed by the sultans of spin to tell the public that the Medical Association will not budge on the fee-for-service issue.

The New Directions proposal also promises that new standards will be put in place for the evaluation of health outcomes. These criteria should have been established before changes were made, not stitched together after the fact. It's quite simple. If we do not know how we're going to measure the efficacy of change in a new system, then we should delay the implementation of the system. To do otherwise is like opening a business before you have identified the product, the market, the financing or the accountability. To most people, that would be ludicrous.

To the NDP, these kinds of objective criteria are incomprehensible. To a government that wants to build an economy around super Crown corporations, cost-effectiveness is simply not a priority.

In announcing the New Directions strategy, the minister said: "We didn't just jump right in with a bunch of preconceived solutions." I beg to differ. The Royal Commission on Health Care and Costs was not tabled as a blueprint. All interested stakeholders expected that there would be open examination of options. The government seems to be of the view that consultation involves nothing more than the cosmetics of various meetings: if you have enough meetings and

[ Page 5437 ]

enough discussion, you can then proceed with your own agenda. True consultation involves setting out your options in a clear, defined manner, and then letting the public evaluate. This was not done before the New Directions strategy was put in place. The government cannot point to a single document outlining its intentions to restructure health care, for which it asked a public assessment before its February announcement.

The relationship between the community health councils and the regional health boards -- as suggested in the strategy -- is loaded with uncertainties. What will be the precise authority structure between these two organizations? What role will the ministry retain in terms of mediation? What kind of skills and administrative and financial resources will be required to make them work?

Community health councils will include representatives elected by the public. Who else will be included? These councils will apparently have the ability to identify local health priorities. The documents do not say how extensive this ability will be. If these councils can define priorities but not have the mandate to address them, they are little more than glorified focus groups. Will the regional health boards simply rubber-stamp the local health council priorities? When it is time to allocate the regional health budget, who will be responsible for gathering the data to verify or challenge these priorities?

It is not as though the same professional functions can be put in place in all communities in order to give them the ability to manage local health care. By the government's own admission, the distribution of health care resources is inequitable. How will we determine what types of administrative capabilities are needed in communities before this system is launched on a fast track?

[R. Kasper in the chair.]

It appears to me that there is a lot of wishful thinking in this program. It just doesn't stand up to analysis. Community health centres are described as the key mechanism to coordinate services at the local level and to be a one-stop centre. Yet ministry officials would be the first to admit that all small hospitals under the present system cannot produce any economies of scale, because of their limited size.

They will be the first to tell you that in the hospital budgeting process they have to set aside special treatment for small facilities, because when it comes to efficiency, small is not automatically beautiful. Will this problem not be aggravated by the establishment of perhaps hundreds of community health centres? Are we not being totally unrealistic and perhaps unfair in telling the public that these will be one-stop centres for health care?

In her documentation, the minister admits that there is no prototype for these community health centres. They will have different shapes, styles and construction, depending on the community they will serve. So how are we to apply any standard of measurement? It is a basic management principle that measurement requires a degree of uniformity. Here we have a government promising precise outcome measurement, and at the same time establishing dozens of local health care centres with different structures.

More vague and misleading announcements are made with respect to the provincial health council. We were told that this council will set provincial health goals so that we can measure progress towards better health over the years. What kind of goals will these be? Will this be a case of epidemiology or philosophy? If it is the former, if these goals are actually based on arbitrary reductions of specific diseases and disabilities, then how can the management be scattered through hundreds of microinstitutions? If, on the other hand, these goals are philosophical, what is the point?

The provincial health officer will be given the mandate to monitor and comment on emerging health issues. This government's success in setting up the token honest person is something less than spectacular. I would suggest that whoever is given this role might wish to have a talk with Stephen Owen in order to find out what kind of survival gear is needed for twisting in the wind. In a similar vein, no attempt is made to provide detail on how the ombudsman will expand authority into hospital boards and professional bodies -- on how this process will work and what it will cost.

There is a simple declarative statement in the New Directions document that would deserve a place of honour if we all had a hall of fame for naive statements. I quote: "A goal of this plan is for British Columbians to spend less time in the hospital because we will be healthier." That is an awesome statement, hon. Chair. It presents a new form of healing that we can all call better medicine through press releases. The minister has announced that we will simply be healthier, and I suppose our duty is now just to get on with it.

In one of the few references to costs in the New Directions strategy, the government contends that only 3 percent of our health care budget is spent on preventing illness and promoting good health. This statement is utter nonsense and is an insult to the caregivers of this province. It suggests that all medical interventions by health care workers are of a reactive nature. It ignores the caring dialogue and concern in the practitioner-patient relationship.

It alleges that the focus on prevention is a preoccupation only shared by the bureaucrats in the Ministry of Health and that prevention is a revelation to the health care practitioners in this province. It is no wonder that relationships are acrimonious.

Specific actions under the five goals in the New Directions policy range from meaningless to contradictory. Under the goal of prevention we are informed that there will be a continuing effort to reduce the use of tobacco and alcohol; to consider doing otherwise would be unthinkable. We are also informed that a health policy for rural areas will be established -- a great irony given the government's determination not to back a family practice program at the University of British Columbia medical school.

What is the point of developing a health policy for small communities if you don't support the training of physicians to work in those same communities? We note that there will be a province-wide surgical waiting-list registry

estab-

[ Page 5438 ]

lished. This is an interesting exercise while government is reducing the number of acute care beds.

Much is made of the public's right to know, particularly with the promise to distribute information about health care costs. This will have little value unless there's more participation in the development of health care budgets. The government is clearly not prepared to open up this process, however, and that is the basis of the deadlock with the British Columbia Medical Association. As part of the goal of taking decisions to the community, there is a commitment to recognize the Ministry of Health in order to facilitate this goal, but we are left without detail. What functions? How many people will move?

What will it cost and where will they go? Similarly, with the reorganization, we are told that care is going to be moved to less expensive settings. But health care is primarily a people business. If we are moving acute care workers, who are at the upper end of the salary scale, to new community facilities that must be built in order to accommodate them, it simply doesn't appear that there will be any saving.

In

summary, the New Directions policy is poorly conceived, inadequately planned and totally lacking in cost analysis. Because of these weaknesses, it started to fall apart within two weeks of introduction. The health care workers are not buying into it, and the government scrambled to build support by putting together a backroom agreement. I refer here to the infamous health labour relations accord. I would like to spend some time discussing why this happened, how it happened, what it could cost and why it appears to be falling apart.

The first question is why it was necessary to put together a new accord. We already had collective agreements in operation with the health care unions in this province. The answer is provided by the government in its own pronouncements. The government admitted that without the support of the unions, the New Directions program would not occur. It admitted that the endorsement of the unions was absolutely essential to the success of the New Directions program and, therefore, to the success and stability of the British Columbia health care system.

If that agreement, which is now in doubt, was so important, where was the Minister of Health when it was put together? On Sunday night, March 14, the board of the Health Labour Relations Association met with the government to discuss the proposal. The meeting was attended by the Minister of Finance, his assistant, the Assistant Deputy Minister of Finance and the Deputy Minister of Health. The most important agreement -- essential to the continuity of health care in this province -- was determined without the participation of this minister.

Moreover, how can this minister present these estimates today with any certainty that the figures are reliable when the entire restructuring of the system is in a state of uncertainty? Let there be no mistake: this agreement was not negotiated by the Health Labour Relations Association. A government delegation met with a committee of the board of the HLRA. A separate government negotiating team met with the unions. The result was a framework agreement superimposed over the three collective agreements in place, but it stands -- and it falls -- as a government document.

It is not the end result of a consultative negotiated exercise. The New Directions strategy, upon which this minister has staked her political reputation, appears to be coming apart with the rejection of this accord.

[3:15]

It is important to take a close look at this flawed deal and its cost implications. The government tabled a non-negotiable compensation package with the employers. The components of the package were as follows: April 1993, a 1 percent pay equity increase; July 1993, the workweek reduced to 36 hours; April 1, 1994, a 1 percent pay equity increase and a 1.5 percent general increase; October 1, 1994, a 3.7 percent increase across the board for the health employees union; April 1995, a 1 percent pay increase and 1.5 percent general increase. Employment security provisions were also extended.

The stated intention was that 4,800 positions -- about 10 percent of the workforce -- would be reduced in acute care facilities through transfers or early retirements. These moves would have to involve prior consent and a commitment not to create an excessive or unsafe workload. A number of casual employees were included in this protection package, but this number was not disclosed. Approximately $20 million was allocated to severance and adjustment packages over and above the cost of this agreement, in addition to a number of relocation and training concessions for which there was no detailed cost analysis.

The deal is now foundering. It is now time for this government to show us the real numbers. There have been a number of independent assessments of this agreement. It is interesting to look at the costs involved in reducing the workweek from 37.5 hours to 36 hours without a loss of pay. This amounts to a reduction of staff by about 4.17 percent. There are 45,000 employees in the system. I assume -- and I think the minister would agree -- that they are all working hard at essential jobs and are needed where they are. So a cut of a little over 4 percent is equivalent to about 1,900 employees.

At an average salary of $30,000 a year, that cut in the workweek means that the hospitals will have to find about $2 million in payroll money to fill in the lost staff time. Actually, the numbers can be even higher. No wonder it was rejected.

In terms of cost in the agreement, different assessments can be taken to arrive at a reliable estimate. If all facilities decide to replace all the staff hours that would be lost as a result of the proposed cut in the workweek, the projected cost of the three agreements for the next three years would exceed $500 million. If none of the facilities replaced any of the staff lost over the next three years, the cost would still result in approximately an additional $200 million.

The difference is about $200 million, which is the same as the figure I suggested for replacing a little over 4 percent of the workforce of 45,000 people over the next three years. By any calculation, the statements by the acting Minister of Health, who at the time of negotiation was the Minister of Finance, echoed by the absent Minister of Health to the effect that this accord would cost only $50 million, has absolutely no validity.

[ Page 5439 ]

These additional costs relate to salary costs only. At any time, hourly rates are increased and number of benefits are increased as a direct result. When we move to a 36-hour work week, we are effectively changing the hourly rate.

For estimates purposes: for a general duty nurse, the move to a 36-hour week would be an hourly pay adjustment from $23.50 per hour to approximately $24.50 per hour. Some of the other benefits which automatically increase when this happens include long-term disability benefits, Canada Pension Plan contributions, contributions to unemployment insurance and the WCB. These costs are not reflected in the $200 million or even the imaginary $50 million surcharge created.

There are more hidden charges. If in March 1996 the employees of the BCGEU receive 0.6 percent more than the three unions in the accord, there would be an across-the-board increase. If this government decides to cling to power in the dying days of its mandate, it will be around when that 1996 BCGEU contract is negotiated. We can assume that would be the final desperate payoff to union friends by this government in its futile attempt to stave off an election disaster. We can assume there will an extra adjustment in the accord.

This agreement -- and the extra sweetener is now being added as we speak -- creates tremendous uncertainties. Many of these will have direct cost implications we do not see reflected in these estimates. The early retirement package of $10 million was presented without any cross-reference to any number of people who may not be eligible. Is this being increased? The accord did not make any provision for non-union personnel, though it will have a tremendous impact on them. Are they being added?

The Chair: Time, hon. member.

D. Jarvis: I'd like to extend my time to the critic's for Richmond East.

The Chair: Hon. critic, please proceed.

L. Reid: The accord did not make any provisions for non-union personnel even though it will have a tremendous impact on them. Are these being added? Again, if this estimate debate is to have any relevance, we need now full disclosure of what is on the table.

There have been suggestions from one of the unions that the 36-hour workweek guarantees ten extra days a year with full replacements -- and a reply from the Ministry of Health saying that the reduction in the workweek will not require any replacement. Is the suggestion here that those health care professionals were not needed for that extra one and one-half hours per week? While government is introducing a New Directions policy with the goal of putting the management of health care in the hands of the managers, what does this accord tell us about the future of management rights?

By pushing the employer aside to cut a midnight deal, was the Minister of Health, with the concurrence of the real minister, sending a message on who the managers would be, on who would be in charge of health care in the future? To what extent is this government prepared to override employee-employer relationships in advancing its own agenda in social engineering?

The accord contains no clear statement with respect to the stage at which comparable job offers have to be made to employees who may be displaced. It does not define comparable. It does not define region. Yet we are asked to believe that the whole process would work on the basis of employees taking comparable jobs in other regions.

The proposed accord had something called the shared risk arrangement to be administered by a committee of people from different health care facilities. This committee would apparently distribute funds to facilitate the cost of maintaining staff if these facilities were unable to find alternative employment for their employees. This was surely a loaded component of the arrangement. Who would decide whether these facilities had taken all reasonable steps to find alternative employment? Would it be the committee, which does not have hands-on familiarity with each facility?

Would it be the employees or the employer, and would they have to agree? How much money was provided, and how much would be available to each facility? What evidence would a facility have to provide that it had tried alternative arrangements? What evidence would employees have to provide that they had considered them and found them unacceptable?

We have a process here whereby thousands of health care employees are going to be in limbo. The answer so far has been that there is a dispute between the facility and the employee on the issue of comparable opportunity, and while the shared-risk committee is funnelling money into the disputed situation, the employee in question will continue to work in a casual capacity. This will cause tremendous morale problems, as talented people are treated as casual labour until the dispute is resolved.

It will mean that community facilities will be built, but they will be without staff until these new circumstances are resolved. It will probably mean that the government will have to hire additional casual employees at the community level. All of this is over and above the $500 million extra cost estimates. That amount is greater than the entire budget of ten separate ministries, yet it is not accounted for in these estimates. As we speak, the package is being increased.

The entire proposal to reduce hospital employment by 4,800 positions is predicated on the placement of employees in vacancies at the community level or those created through attrition, early retirement, job sharing and a shorter work week. No numbers were given for any of these outcomes.

The questions greatly outnumber the answers. On the question of voluntary retirement, the assumption is that employees targeted for layoff will be qualified to fill the positions of employees eligible for retirement. This just simply doesn't make sense. The accord established a principle of codetermination in terms of unions making operating decisions in the hospital environment. We will not be able to retreat from this position in the future. Until we know the numbers, there can be no accurate accounting on the full costs of

[ Page 5440 ]

the accord, wherever it may currently stand. It therefore draws into serious question the figures in these estimates and the reliability of the government's projections.

A few examples will suffice to show us how much uncertainty there is and how many millions of dollars are involved in those uncertainties. For example, hospitals would be required to pay one-third of the cost of the lump sum payments for topping up pensions. These costs are admitted to be as high as $10,000 per employee. If half of the 4,800 employees should decide to exercise retirement options, the cost could be staggering.

The ministry has agreed to pay the first two weeks' salary for each laid-off worker at a new facility. Travel expenses for two people will be paid for up to five days in order to check out accommodation for new positions. If accommodation cannot be found, the ministry has agreed to pay full expenses for an additional seven days, with a further provision to pay full expenses for families and dependents for up to 60 days. There is also an agreement to pay over $5,000 in real estate and legal fees and to cover duplicate rent.

For employees who are not successful in finding alternative employment within the system, the ministry has agreed to fund long-term education, such as for a bachelor's degree or training in the non-health care fields. If an employee returns to school under this program but then a vacancy is identified, the ministry will continue to pay tuition and child care expenses while the employee completes their education. At the same time, the ministry will pay for a casual employee to fill the job, which is to be kept for the employee who is at school.

The ministry has also agreed to supplement unemployment and benefit plans. This would involve paying up to 85 percent of an employee's salary by paying a differential over unemployment insurance. For a typical employee, this would represent over $5,000 in supplemental benefits over and above the education benefits described. None of this is costed out in detail.

We need a full and open accounting of all these costs, or we are wasting our time here, hon. Chair. What makes the situation even more unstable is that while we have thousands of employees in limbo in the hospital environment, working as casual help while committees mediate disputes, vacancies may not necessarily be cropping up at the community level. Under the proposed agreement, a vacancy is defined as the position which is vacant after completion of all internal posting processes under existing collective agreements.

Anyone who expects that community-level jobs will suddenly materialize is going to be sadly disappointed. This accord is the major failure of this government. It has been rejected by management; it appears to be losing labour support as well. It is a financial and labour crisis in waiting. It absolutely negates the self-congratulatory claims this government has made about its approach to health care.

This government is not willing to let the managers manage, it is not willing to keep its meddlesome fingers out of employer-employee relationships, it is not willing to consult openly, and it is not willing to exercise cost discipline.

Nowhere has this government's sorry record on health care had a greater failure than with the doctors. This dispute has now dragged on past all levels of public tolerance. By its very actions, this government has flagrantly embraced the kind of excesses which it would condemn on the part of the doctors. This ministry has seen its salaries and benefits increase at more than twice the rate of inflation -- even higher than the minister's office.

It has seen Medical Services Commission costs for administration enter the double-digit figures, while total benefits distributed to the people who need them have increased less than 1 percent. It has increased medical plan premiums by more than three times the offer for real, increased compensation to physicians. Most regrettable has been this government's continued attempt to drag this dispute down to the lowest level of confrontation.

[3:30]

There is an old expression that says mud thrown is ground lost. This government has lost a great deal of ground in its dealings with the medical profession, and all of us are worse for it. For its part, the B.C. Medical Association has tried to put forward a reasonable compromise. Physicians do not canvass for patients on street corners. The demand for health care is driven by public expectation. Nor can physicians be faulted when new techniques and new technologies make medical intervention a possibility for larger segments of the public.

The doctors have openly indicated their willingness to participate in the Medical Services Commission with the reasonable request that this commission be free of unrestricted cabinet interventions. Surely this is a reasonable caution to sound after the example of the health accord. The profession is proposing architecture for negotiation, dispute resolution and fund management in a manner that will move us away from the long-term dispute.

The doctors view with concern the spontaneous attempts by this government to redesign the health care system, and have asked that such changes be implemented on a pilot basis and be subject to timely and scientific evaluation. These do not seem to be unreasonable demands. With respect to the government's contention that the doctors do not wish to submit to legislative authority, the position of the profession has been quite clear. In its proposal to government it states:

"The physicians of B.C. understand and acknowledge that the Legislature has the right to determine the amount of funding to be allocated to medical care. At the same time, doctors expect the government to provide a process which allows meaningful input in the budget exercise and ensures that the results of any fee negotiation with government may not be subsequently overturned."

I see no stiff-necked resistance in this request.

With respect to the tripartite Medical Services Commission, the BCMA has suggested a period of orientation and adjustment so that the commission can become adept at the issues before asserting full authority. This would seem to be far preferable to the fools-rush-in approach which has been used in the New Directions policy. Under the doctors' proposal, each year the Medical Services Commission would develop a budget request which would become a matter of public record.

[ Page 5441 ]

Where there is a difference between the amount requested by the commission and the amount allocated by the government, a process of restraint would be initiated. The doctors propose that government would take a role in defining the scope of insured service in circumstances where it does not have the money available to meet demand. In turn, the government seems to be of the view that additional services should be on the house.

These proposals acknowledge government control to determine the level of funding. They move in the direction of a balanced Medical Services Commission, and they place some onus on the public for responsible use. So who is being unreasonable? Who is obsessed with control? The BCMA further proposes that in the event of a dispute the parties would be able to call upon the assistance of a conciliator and a mediator if they are unable to reach an agreement. They suggest that the recommendation of these individuals would be a matter of public record.

Most importantly, they categorically state that they respect the right of the Legislature to unilaterally determine the amount spent on medical services if all of this fails.

In essence, what is being requested here is a process that involves neutrality and openness. It is a process that commits the government to seeking the best possible level of advice and consultation before making a decision. Those key words should ring a bell with this government: openness, consultation, effectiveness. Why this minister finds this reasonable approach unacceptable, and why she prefers to perpetuate a bitter and destructive dispute for short-term political gain, is beyond the understanding of this opposition and the people of this province.

Hon. Chair, when you listen to this government describe its approach to health care, you hear high-sounding words of self-congratulation. But when you listen to those who've been on the receiving end of the process, the language is quite different. One of the many professionals at Shaughnessy Hospital who wrote to us, said: "I am disgusted that the current NDP government, without any prior consultation, should arbitrarily decide to close a hospital.

A calculated newspaper leak and the subsequent firing of the joint hospital board four days later is the hallmark of this provincial government." A letter from the physicians at the British Columbia Health Research Foundation states: "In essence, the 75 percent reduction in budget is the second unilateral decision by this ministry within the last few months which was executed without warning and without consultation."

Comments such as these reflect a widespread public mood of disillusionment rapidly turning to anger. Promises of consultation are now seen to be nothing more than a shallow public relations exercise. Commitments to participate have lasted only as long as it took this government to see that direct heavy-handed intervention was necessary in order to protect its own agenda. Comments about respecting the profession have not been matched with actions. Lip service to the discipline of good planning has been shown to be nothing more than empty words.

It is not enough that promises have been broken, but expectations are now being created that simply cannot be met. We are heading for a period of instability and unrest caused by needless, impetuous and ill-founded meddling with one of the finest health care systems in the world.

In many areas of endeavour the incompetence of this government can be accommodated, and the damage will be fixed once their stay is terminated. But I am concerned that the havoc they are creating in health care will last years beyond their ill-fated regime.

L. Fox: Before I get into a very brief presentation, I do want to thank the minister for making available her staff to brief me last Thursday evening. Although it was only an hour long -- it was my time frame that was a problem, not theirs -- I certainly appreciate that they were doing their best to explain, within the very short time we had, some of the ramifications of the budget.

Over the course of the estimates we hope to approach the many initiatives that have taken place over the past year, and we look forward to further initiatives in this budget year. If I have a disappointment, and if the people of the province have a disappointment, it's with the promise that this government would provide open, honest and consultative government -- that it would stop the process of confrontation.

Yet what have we seen over the course of the last year? Shaughnessy Hospital did a strategic plan as to how they might fit into the scheme and, as I understand it, presented that plan to the ministry on July 31, 1992. The only answer from the minister to that presentation was, in fact, on February 14, when the board was fired and it was announced that Shaughnessy Hospital was being closed. That is not what I see as consultative; in fact, once again it has promoted confrontation.

When we look at the Closer to Home initiatives and the royal commission's development of some concepts.... That's what I prefer to call them, although the minister consistently talks about it as a blueprint. I don't believe we can expect any royal commission to come forward with a blueprint. I believe that they go out and speak to the people and come forward with some recommendations for consideration. At all levels of government we have a history of making mistakes, of acting too swiftly and of not having enough stability in the process to make the evaluations prior to committing ourselves and millions of dollars towards something which doesn't turn out the way we envisioned it.

To illustrate that, I'd like to discuss two particular initiatives that I'm familiar with and which cost the provincial government of the day millions of dollars. The first was the open classroom concept, where we designed schools that could accommodate more than one class within the same room. The feeling and the idea at that time was that a child in grade 5 would gain significantly from the questions asked by a child in grade 6, and so on.

We spent millions of dollars building facilities to accommodate that particular initiative only to find out a few years later that it didn't really achieve the things we as a government expected. Then we spent millions of dollars again changing our schools back to the traditional one-classroom types. When we look at the education 2000 process and at the difficulties

[ Page 5442 ]

we're having with teachers, school boards and the public accepting that we've spent millions of dollars so far on something which may have to be reduced substantially.

I'm concerned that we've moved too fast in the Closer to Home process. In fact, I and the people of the province would have much preferred if we had identified two, three or four pilot projects -- urban, semi-urban and rural, perhaps -- so that we could try the concepts recommended by the royal commission. Through that process we could have done numerous things. We could have looked at what the displacement of our health care workers would be and how we might best retrain them to fill in the gaps and to offer the New Directions of this new program. We could also add some accountability to the process.

We could have examined whether these concepts were going to meet the objective of delivering a top-quality health care system at a lower cost. I think that's the objective that this Closer to Home process is trying to meet. Many of us are concerned it isn't going to meet that objective, certainly not in the rural parts of the province. We will canvass those, hopefully at some length.

Most of us understand that there is always resistance to change. I've been part of that resistance at times, and I've also been part of the group which tried to implement change. I've seen it from both sides, and I do understand the difficulties. If change is going to happen in the best interests of all British Columbians, we have to have all the health care stakeholders -- the workers, the doctors, the administrators, the health boards -- agree that there is a worthwhile objective. It's going to take mounds of consultation to achieve that. The disappointment I find now is that we haven't seen that.

I believe that even in these very difficult times British Columbians would have accepted a moderate increase in health care to examine the new initiatives. Taking away from acute care and putting it into a system as yet undefined -- and certainly we don't have the ability to examine whether or not we have the efficiencies in that system -- is causing a lot of concern with the public of British Columbia and, I think, with the health workers.

It's rather unfortunate that we've seen the Finance minister do an end run on the Health minister and the HLRA in order to strike a deal with the health workers. The noise from the leaders of those three unions was mounting, primarily because of the initiative to close Shaughnessy without any consultation. Those workers all saw themselves being placed out of work. Obviously the union leaders felt there was a great opportunity now, and I don't blame them. Had I been a union leader or one of those union members, I think I would have said: "The government's in trouble with this decision. We've got a great opportunity here to negotiate something better than what we have."

Earlier today in question period the minister suggested that most of the 4,800 layoffs will occur through attrition and perhaps some early retirements. But we've seen huge cuts in my particular constituency; we've already seen huge cuts in the Prince George hospital of some 60 employees last year; and we're seeing projected cuts this year of 26 to 30 employees, based primarily on the fact that they are going to have to fill the gap from the 371/2-hour work week down to a 36-hour work week, which has a net effect on that hospital of 4.1 percent.

With hardly any exception across the province other than Surrey, those hospitals are all achieving less than 1 percent on their global budgets. As I understand it, approximately 70 percent of their budgets are salaries, so those kinds of things just don't equate.

[3:45]

That particular agreement and that end run done by the Finance minister would never have had to be if the Health minister had dealt with that situation in Shaughnessy up front, if the ministry had met with those people and said: "Here are our concerns, here are our problems. How are we going to deal with this?

How are we going involve all the stakeholders in our shift?" We've heard various reasons why Shaughnessy was closed -- everything from moving those beds to the Fraser Valley, which we found out was incorrect; those were extended care beds, not acute care beds -- and now we find that the spinal unit may have to be moved twice instead of just once. All this is additional cost.

I find it horrendous that the minister would make a statement that it was in the best interests of the health care of Vancouver when 40 percent of the University Hospital and Shaughnessy Hospital's clientele comes from outside the Greater Vancouver Regional District area. So in fact this is a provincial hospital, not a Vancouver hospital; and the decisions there impact all of British Columbia, not just the people right around that area.

I really don't have the answers as to whether it's a right or wrong decision to close Shaughnessy, and I have yet to state publicly or in this House that Shaughnessy should not be closed. But what I have said repeatedly is that the process should have been complete before that decision was made.

I believe that the health care professionals, the unions and the doctors all would have supported the process and the eventual decision had they had the opportunity to give their input, rather than having it forced upon them with the blind statement that there was a $40 million savings and that the hospital was old and decrepit. The $40 million saving is questionable. The statement about the hospital being old and needing replacement is also suspect because many millions of dollars have been spent to upgrade that facility over the past 15 years.

I hope we can canvass at some length what the structure and responsibilities of the regional health care boards will be. There is a huge vacuum in the public's understanding of what these things will be, what their mandates will be, even who's going to be under their jurisdiction and what role they will play in hospital funding within those regions. The minister talks about core funding being supplied and that if there is anything beyond the core they would have to look at some form of local initiative. The minister shakes her head, so perhaps she can clarify that.

But certainly those statements have been made in the press, that core funding will be available. True, the minister didn't identify what the core funding would be, but it left a lot of questions in the mind of many rural British Columbians about how it would affect them.

[ Page 5443 ]

Another concern that we will get into with respect to that is on what basis the funding will be given out. Are we looking at similar formulas to what we see in education, where we have a per-pupil allotment? Are we now going to see a per-resident allotment given to hospital care? What happens when the ratios change? The kinds of procedures and operations required, especially in the smaller regions of the province, change from year to year. The expense can change dramatically. With that I will take my place and I look forward to considerable dialogue on the formula for that kind of payment and to the questions and answers over the course of the estimates.

Hon. E. Cull: I would like to start by thanking the member for Prince George-Omineca for what I thought were his very thoughtful comments and questions. I will not take a lot of time to reply in detail to the things you've raised right now. I'm assuming that you will have specific questions to put to me. I want to just touch on a few things. I'll start with the last one with respect to your comment about core funding.

I need to clarify the record. It is not I who said that core funding will be provided and that local initiatives would be required to raise any additional funding. Indeed, it is the leader of your party who has been quoted as saying that. During question period in the House I have corrected him on that on at least one occasion.

The intent is that, as we do right now with hospital services, we will identify those services which must be funded out of the money that we will be providing in global budgets -- at some point down the road, I might add. This is not happening this year or next year, and it may not happen the year following that, except for the most advanced health boards in the province.

The intent is to set some standards around services so that people know, no matter where they live in the province, that they can expect to receive a certain level of health care service -- whether it is acute care, mental health, public health, continuing care, or what have you -- that is fitting with the size of the community they live in, excepting that there will be different standards of service in different sizes of community.

I think we all do accept that; we don't expect heart surgery in every community in the province, but we do expect a certain basic level of service that increases with the size of the community.

The way that this will be approached is by looking at how we do it right now. Implicit in our funding formulas -- whether it be through care services to hospitals or through mental health within the Ministry of Health or, again, through care services to our long-term care facilities -- are some standards of care and some standards of service that are funded for a community.

What I would like to see happen over time, though, is a greater reflection of funding tied to the health status of the community, so that we start to look at the communities -- and some of them are in the part of the province you represent -- which have, on any health indicator you might look at, poorer than average health status. Maybe there are a larger number of low-birthweight babies or more teen pregnancies, or maybe there is a higher rate of injury, alcohol abuse or cancer. There are a number of ways that we can measure the health of people in this province.

Not all areas in the province are equally healthy. I think we should be targeting our resources to those areas that have the poorest health, and that, I think, has to become part of our funding formula.

You talked about the speed of health care reform, and this has been an ongoing debate with people in the health care field. Some people are very frustrated with the slowness at which some changes are being made. I think that a six-year period -- which is essentially what we're looking at -- is not too short for bringing about some major changes in health care.

I say six years because the royal commission spent two years in extensive consultation around their recommendations; we spent another full year, again in extensive consultation around how to implement the royal commission's report; and now that the New Directions strategy has been released, we are looking at approximately three and a half years to full implementation. Some things will not even be implemented within that time frame; they will have a longer horizon.

There has been a lot of discussion around the consultation. I appreciate that not all members on this side have participated in the processes -- which were many -- we used to undertake a review of the royal commission's recommendations. As you know, there was a minister's advisory committee. I don't know how many meetings it held. It was a steering committee, so it was not the be-all and end-all of our consultation. There were also six working groups, which involved people inside and outside the ministry and representatives from major organizations.

There were 13 community meetings facilitated by community-based groups to look at the health needs of their community. There were two major stakeholder forums, which both you and the official opposition critic were invited to attend, where about 150 representatives of various groups came together to review papers which were circulated in advance, and in fact they drafted parts of papers. So a lot of discussion and consultation had taken place before we came out with the paper.

In terms of the speed of the reforms and the way we went about looking at the royal commission's recommendations, we've had a very thorough process. We may want to discuss that a bit further in questions.

With respect to comments made by the official opposition critic, I want to congratulate her on a speech that I'm quite familiar with, having sat on that side of the House and listened to people on this side. It's very easy in opposition not to let the facts get in the way of a good political argument. Indeed, you've made some excellent political statements, but unfortunately most of them are factually incorrect.

Starting with the statements you have made about the labour accord, I don't know whether you've deliberately done this or whether you just don't understand the difference between the labour adjustment program and the social accord that is the result of this tentative agreement, but you've confused the two. You've put them together and talked about parts of one and parts of the other as if they were all one package. Last year

[ Page 5444 ]

there were about 90 placements under our labour adjustment strategy, for a total cost of $114,000 for the full extent of the labour adjustment program dealing with laid-off workers.

The things you talked about in terms of what happens to WCB benefits, pensions and all of the other benefits are, again, inaccurate, because the tentative framework agreement only deals with wages; it doesn't deal with any of the benefits. In fact, from the employer's point of view, that's one of the attractions of the package. It's not very often that you get to open a collective agreement for two years and only deal with wages and not have to get into benefits.

In her remarks, she made a number of statements that I found quite contradictory. She talked about community health centres being different in every community, and how in the world that could be. Then she talked about the need to represent community values and have flexibility. I don't see how we can take a cookie-cutter approach and stamp out community health centres, as well as reflect communities' needs, which I think is far more important. We recognize that what Kitimat needs is probably different from what Nelson needs and may be different from what Victoria needs.

We need to look at what really is happening in that community, what the opportunities there are now and how we are going to work on those.

The member talks about the various themes in the New Directions paper and makes fun of the respect-for-the-caregiver theme. But most of the remarks she made with respect to nurses and other health care professionals were slamming anything we have done to recognize the very valuable services these people provide and the need to keep them in our system and be part of health care reform.

I find it hypocritical to talk on both sides of this issue without recognizing that one of the major thrusts of what we have tried to do with the framework agreement is to keep the talented health care professionals working in health care and make it possible for them to move from one facility to the next -- from the acute care sector into the community sector -- and to carry on providing good health care services to people in the province.

I was rather amused to hear the proposals for budget participation by the physicians in the province and the language around that. That is the language we have proposed. It has been in our offers to the BCMA right from the very beginning, and it remains in the final offer that's there now.

With respect to mediation on fees and benefits, I'm happy to tell the member -- I could share a copy of the agreement with her -- that we have accepted the BCMA's language on mediation of fees and benefits. That is part of our proposal at this point.

[4:00]

I'm sure we will canvass this in some detail later, but the member is again incorrect in terms of the B.C. Health Research Foundation. They actually have more money to spend this year than they did last year. In terms of extensive advance notice on consultation, we've given them two years' notice that there has to be some change in their funding arrangements. I can't imagine how we could give them much more warning than that. I suppose we could have given them three years, but that would have been entirely impossible, given the timing of the provincial election.

I think I will stop at this point. Before I sit down, I'm going to take this opportunity to introduce my staff who are here with me today. I'm sure that some of you have met the staff, but just for the record we have Doug Allen, who is the deputy minister for at least the next six weeks. After that he is moving to Hawaii, where I'm sure a lot of us wish to visit him from time to time. Next to me is Les Foster, the assistant deputy minister in corporate services, and Brian Copley, our assistant deputy minister for community and family health.

Directly behind me is Vicki Farrally, our new assistant deputy minister of care services. Next to her is Peter Cameron, our assistant deputy minister of strategic services, and, finally, we have Gillian Wallace, assistant deputy minister and the chair of the Medical Services Commission.

V. Anderson: I listened with great interest to the discussions that have taken place, and I refer particularly to the community in Vancouver, of which I am a part. But just before I do that, I have to make some historical comments, which the member from the third party commented on.

I can remember back in the forties when -- some people in this House probably weren't even around then -- the medical program that came out of Swift Current, Saskatchewan, became the model for medical services in Saskatchewan. At that point, community health clinics, closer-to-home programs and many of the discussions that this ministry is putting forward about the present Closer to Home program are all things we heard about some 50 years ago. So we go around, and things are not that new. Many of these programs were experimented with at that time: community clinics in which doctors were on salary.

There may even be one or two of those continuing in Saskatchewan, because I know for a long time two of them were continuing within the cities. I've had a fair bit to do with rural hospitals in small localities attempting to provide services to these out-of-the-way places. So much of what I'm hearing in the discussion, in principle, is not new. It's been around for a long time, and it's gone around the circle a number of times. Each time we come around the circle, it's often presented as if this was the latest thing, it's never happened before, and this is going to solve all of our problems.

I think one of the realities we've learned over the last couple of years in a number of issues -- not only within health care but within education, in constitutional discussions and whatever else -- is that policies and programs, no matter how good, tend to break down when the people themselves are not involved in understanding them. The more we talk about the involvement of professionals -- at whatever level -- in planning community activities, the more the local community people become suspicious that everyone else are "the experts" who are making the decisions.

As I've been reminded a number of times, experts are simply people who are away from home and people who talk about something that's happened someplace

[ Page 5445 ]

else, but it won't work in our community. If for no other reason, then we won't let it work in our community; even if it's good, we won't necessarily let it work in our community. The top-down decision-making is becoming more and more difficult and people are reacting against it.

Unfortunately, in the present discussion about closer-to-home health care, what we seem to be hearing from the community level closer to home and the people I visit at home is that that's what is happening at the present time: that it's a top-down process. "Some consultations have taken place; some discussions have been held with stakeholders, but we weren't part of the people in the discussion; and whoever they were, they don't represent us." I'm finding a very strong antagonism growing from that understanding that the local community people across the province are not in touch.

I raise that because I think that's a context in which we all have to act at the moment. I am reminded of a social planner in Regina, Saskatchewan, who commented one day: "We can develop the perfect plan for this community -- with one flaw: the people of the community will vote against it every single time." That's a reality that we have to take into account. The people of the community want this to be their project, their undertaking and their ideas.

Even if it doesn't work the way the planners say it should and could work better for us, that's still the style of this community, and that's the way we want it to work. I think we have to realize that the more we put forth the perfect ideas, the less they will be accepted and adopted by the people we speak to.

I bring that in context, because I've been interested in this last vote, where 55 percent of the voters and employers voted to accept the present contract and 45 percent rejected it. The immediate response was from a union member: "Are we going to let a minority of people push the rest of us around?" I don't know any union group that doesn't argue that the minority is also as important as the majority. The very argument of saying that 55 percent -- which was not the required number under our system -- is not enough, in itself defeats our argument. I don't think we can use that argument, because it comes back to us as a negative, trying to force our will on somebody else.

When most people think of medical health care -- particularly when this government starts to talk about prevention and closer-to-home cure -- they aren't thinking in the technical, medical jargon of beds terminology. They're not thinking of hospitals in terms of beds; they're thinking of hospitals in terms of dealing with immediate needs. Many people think of hospital care in terms of the emergency ward, where people do not occupy a bed but are simply treated and go home.

That's relevant in our community when we talk about Shaughnessy Hospital, because a very high percentage of the people who use Shaughnessy Hospital are day patients who come in for part of the day. They receive treatment, they go home and they come back the next day. They're not staying in beds.

This part of the discussion has been totally overlooked and disregarded. It's not simply a matter of beds. In fact, the number of beds is almost irrelevant to the concerns of the people in the community.

One of the realities in the Shaughnessy discussion, and I have it brought home because I have more than 4,000 faxes that have come through our constituency office, individual faxes signed individually from Shaughnessy people who are concerned about that program. That's more than 4,000 from our Vancouver community alone, plus letters, phone calls and all the other representations. All the people who were at the rallies didn't get around to sending faxes, writing us letters or phoning us. Sometimes we're just as happy they didn't because we didn't have time to deal with them all.

There's a groundswell out there of people saying: "Closer to home? We have a facility closer to home. You're taking it away from us, and it will not be closer to home for us who live in this particular community."

[E. Barnes in the chair.]

You may say they're being selfish. The very point the Closer to Home program is trying to make, by the actions undertaken as far as these community people are concerned, is totally the opposite and denies the validity of the program itself.

Another part of the concern is the integration among Grace Hospital, Shaughnessy Hospital, Children's Hospital, the Veterans' Hospital and the multitude of programs operating within those hospitals on an interactive basis. The people see a whole community and teamwork of medical care. It's not the building.

I come out of a religious context as a minister of the church. We've had to learn over the years that it's not the church building that makes a church; it's the people who are a part of it. The building is irrelevant. It's the people who make the program work, not the building. In the Shaughnessy discussion, with the focus on "the building," we miss the point altogether. Shaughnessy Hospital and all those connected to it is not a building; it's a program of people involved in services, interactive with one another. These are people our community lives with and works with.

They are part of the fellowship of that community. What is being attacked in Shaughnessy is not a building; it's the credibility, the viability and the sustainability -- all credible words -- of health care in the Vancouver area. That's what's being attacked as far as the people of the community are concerned; the building is irrelevant.

If we want to talk about the building for a moment.... For some 20 years I've been visiting patients in that building. They have been well and adequately served, and I've never in all that time heard a complaint about the building. That has not been the problem, and as you wander around, you see that the building is well cared for. Its floors are just as shiny as the floors in the legislative buildings. If we make a comparison based on the age of the building, we should run out of here in fear because this building is twice as old, if not older.

You can't go by the age of a building; you go by the usefulness of it. The people who have been in that building and know it inside and out don't see the validity of what you're saying.

[ Page 5446 ]

The message is coming across all wrong. I think that's important for this government to hear. In whatever category they look at Shaughnessy Hospital -- whether it's the building, the team, the community participation, the outpatient services or the active services for the lower mainland and across the province -- what they see being challenged is the adequacy of the program that's been built up over the years.

I don't overstate it much when I say that what they see is an upstart government with an upstart minister coming in and making changes, without becoming acquainted with or being trusted by the people of the community. They don't trust her because they don't know her. If you ask why the change is so sudden and why they cannot accept it, apart from anything else, it's the lack of being in touch with some upstart from Victoria.

[4:15]

One of the realities -- Victoria is a very little place -- I discovered a number of years ago when I came to work in the legislative buildings was that most of the people in Victoria had never been in this building. This is another world. It sits in a part of Victoria, and it's not even part of Victoria -- much less Vancouver or British Columbia. It's that place to which all those people, of whatever party, come to try to destroy our lives. That's the context in which this message comes across.

I want to be particular about one part of the program that is operating in Shaughnessy Hospital at the moment, because this area symbolizes much of what's happening there. We are all aware that a former member of this House, Doug Mowat, was very involved with the spinal unit and with the concerns of people with disabilities in our community. The offices where he worked were located there, and the community is very closely tied to that. So the spinal care unit is a very important part of its history and its participation. They were very aware of the review that took place in 1992 regarding the spinal division.

They're also very much aware of the recommendations that came out of that review. I'd like to remind the minister of those, because these are what the people of the community are asking questions about.

Two weeks ago a member of the spinal community who has had care in Shaughnessy raised these questions as part of the public forum and discussion. From that review we read....

The Chair: Hon. member, I'm sorry to advise you that your allotted time has expired.

D. Symons: Hon. Chair, I found the hon. member's talk very interesting, and I would like to hear him continue.

V. Anderson: Mr. Chairman, I'd like to remind the minister of the recommendations that were put forward, which gave great encouragement to the community that has put so much time and effort into this process. The committee says: "After careful review, we feel that many factors favour the centralization of spinal services at the University Hospital, Shaughnessy site." This is the basic understanding that the people of the community have. From that same document, the strong support of the president and CEO of University Hospital, Dr. Lionel McLeod: "Dr.

Mcleod is strongly supportive of the spinal services at Shaughnessy site, and he will ensure that it continues to be developed and supported as a premier focus."

A little later in the same report:

"Shaughnessy houses one of the premier spinal centres in Canada. It is the only location in North America where all aspects of spinal surgical care are provided at a single site, and it provides the only fully integrated spinal cord trauma system -- including research, prevention, acute surgical and rehabilitative care -- in the country. These attributes combine to make it unique among North American centres offering spinal surgical fellowship training. It has an international reputation, not only for orthopedic care but also for care in related areas."

That's the context. And this same understanding is true not only for spinal care but for all of the other programs found in Shaughnessy site which interact and support each other. This is the understanding that not only the community I serve but all Vancouver residents have about the Shaughnessy site. This is a program that has been built up over years by the cooperation of the best medical professionals in Vancouver -- at University Hospital, at VGH, at Shaughnessy, at St. Paul's, at Holy Family. They've all been involved in building up this program.

In attacking this particular site, if you think, hon. minister, that you are attacking a building, you are not attacking a building; you are attacking the strength and vitality of a community that has trust and care in a team of people. There is a concern among them because as they talk to the members of this team, they are told again and again: these facilities cannot now be provided anyplace else in Vancouver, and the attempt to move them will destroy them.

No doubt it will also mean that many of the professionals who make this team work will leave Vancouver, leave British Columbia, leave Canada -- and if even one of them does, this ministry and this government will be held responsible. I hope the minister is aware of the plank on which she has placed herself, because the community is angry and concerned and will not accept this kind of disruption of a program that has built up over the years. If you talk only of a building, you simply misunderstand what the people of our community are saying.

Hon. E. Cull: It's interesting to hear the member's comments about Shaughnessy not being the building, because I agree with you. It's not the bricks and mortar that provide the health care that you've been speaking so supportively of. It's the people and the teamwork built up at that hospital over the years which has to be protected and preserved, not the physical structure of Shaughnessy, and indeed not even the physical location of Shaughnessy. You talk about its value to the people in Vancouver, and I understand that. I hear that very clearly from people who talk to me about Shaughnessy Hospital.

If we were living in a different kind of world, where we were not having to deal with a 3 percent increase in the hospital portion of the health budget -- when we know full well that inflation in the hospital sector is driving somewhere between a 10 to 12 percent need just to stay still, to do exactly what we're doing

[ Page 5447 ]

this year to carry on next year with that same level of service -- we would go on pouring money into outdated hospital buildings to keep those services in place in the community, and we'd have some ability to expand services in the rapidly growing areas of the province which are considerably underserviced right now.

We don't have that luxury; we don't have that financial situation. The Royal Commission on Health Care and Costs pointed out very clearly to us that the challenge for us as managers of the health care system -- and I use that in a collective sense, not only the Ministry of Health, but also the hospital sector, the administrators who are out there working on it and the people who make decisions about health care planning -- is to start to re-allocate some of that money.

I was at a meeting in Vancouver a couple of weeks ago talking about the Shaughnessy Hospital decision. I was listening to people who were very concerned about what was going to be happening in their community. After a while, a woman stood up at the back of the room and said that she heard what I was saying, but she wanted to put this in some context. She was just visiting a friend in Houston, in the central part of this province, who had gone into labour. That labour became complicated and couldn't easily be delivered in that community.

That woman in labour -- and probably in a considerable amount of stress; labour is stressful enough as it is, but not knowing what your complication is adds to the stress -- had to get into an ambulance and drive one hour down the highway to the closest hospital. For her, closer to home means in her own community in Houston. We need to address the fact that I think that it is unacceptable to have to put a woman in complicated labour into an ambulance and tell her she's got an hour's drive ahead of her.

It's difficult giving up that emergency room at Shaughnessy, but let's put that in context with this woman in Houston.

In Vancouver, we're talking about another hospital available within a five- to ten-minute drive to take those services for those people. I'm sure that everyone would love to have that facility stay where it is and be able to provide those services like it always has, but if we're to start addressing the serious inequities in our health care system and we accept that the solution is not to just keep pouring more money into it.... Maybe you want to argue with me on this one. I've listened to you people on the opposition side talking about how we haven't cut spending enough.

I listened to the opposition critic saying we don't have to cut it out of health care. When health is one-third of the provincial budget, you can't do an awful lot of chopping before you do eventually get to health care. Those are the areas where we really do have to start making some redistributions.

When we look at Shaughnessy again -- and I will tell you that it was not an easy decision at all to have to make -- and at some of the compelling logic that led to that decision, the University Hospital's own task force recommended the replacement of that building, because it was outdated. They changed their position on that recently. I think they changed their position because it was very clear that the ministry was not going to rebuild the hospital.

The Greater Vancouver Regional Hospital District, which has to pick up 40 percent of the cost of any new facilities, as all regional hospital districts do, also had serious concerns about footing the millions of dollars that would be required to replace that old building or, indeed, to keep renovating it. The money that people talk about having put into the hospital -- $13 million over the last decade; not the last couple of years, but the last decade -- is a very clear indication of just how much work that building needs just to keep it operating at an effective and efficient level.

I'm not a hospital administrator; I'm not a nurse. I don't work in a hospital. I go into a hospital, like many people do, to visit people who are sick, or sometimes I go as a patient. When we look at those buildings, they look fine to us. When you look around this building, it looks fine; for its purpose, it's probably more than fine. But if you talk to the professionals who work in older hospital buildings, they'll tell you that not only are they ineffective in terms of places to work but they are also inefficient, they cost more money and they don't provide particularly good patient care. That's another thing we have to consider.

Again, when you are trying to make a very difficult decision and everyone who has an opinion on it has some vested interest -- either as someone who works in the hospital or perhaps in another hospital that might like to receive those services -- you can't do any better than to look at someone like the medical health officer in Vancouver, John Blatherwick who, after reviewing and considering all of the analyses, said that he, too, supported the decision to close Shaughnessy.

[4:30]

You talked quite a bit about the spinal cord unit, and you said that those services can't be supplied anywhere else in the region. I know that the Council of University Teaching Hospitals, CUTH, had a look at the spinal cord services some time ago and said that if they could not stay at Shaughnessy, they could be relocated satisfactorily to the Vancouver General. What we have underway right now is a planning committee chaired by Dr.

Peter Wing and Norman Haw, with the involvement of people who are consumers of the spinal cord program services, planning not only how to best relocate those services but also how to enhance them. One of the commitments we made in the Shaughnessy decision was to enhance the spinal cord program. We're expecting those recommendations at the end of the month.

V. Anderson: I'm not sure we're supposed to be arguing here, so I won't argue with you. But I will follow up on the discussion. Everybody is in favour of enhancing the program, but of course that's going to cost more money. I think it's unfortunate when we try to play off one place against another.

Let me move to concerns in the rural areas. I've lived in rural areas where we've had small 20- and 30-bed hospitals. There was a resident doctor who changed every year or two years, because they could not continue to practise in that particular location by themselves. Trying to service the area involved too much travelling. I sat with a doctor in one of those small hospitals when the roads were closed and there was no

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good way for other medical help to come in to assist him in an appendix operation. He said that he could wait two hours, and whether help came or not, the operation had to go ahead.

One of the dangers in trying to get a closer-to-home hospital in every community throughout the province, so that no one has to drive for an hour, is an escalation of costs. Regarding staffing for those hospitals, we brought staffing into those small hospitals from around the world, and they came and went. We had difficulties because of that, to the point where the local pharmacist who provided the prescriptions for the doctors had to close down, because every time you got a new doctor, he changed his prescriptions, and the old stock was no longer useful. The pharmacist said: "I can't afford to have doctors change their prescriptions under my nose every time this happens."

There are a multitude of problems when you try to move into these areas. As has been mentioned before, I don't feel that the people of the province have the confidence that the ministry has taken all of those practical things into account at this point, whether it's in the rural area or the city. Theories are great, but the practical application is what people are worried about. The general feeling that I have from the people we have visited and those who have visited with us across the province -- both from medical professions and the communities -- is that what is happening at the moment is going to destroy the medical system in B.C.

Apart from anything else, as long as that attitude prevails -- and it's growing day by day -- all of the right actions in the world are bound to fail. We can't simply say -- as the minister has been saying -- that we're doing all the right things, because the peo